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pulmonary > GU > Flashcards

GU Flashcards

1
Q

hematuria definition

A

> 3 RBC/HPF

  • gross: more nonglomerular
  • microscopic: more likely glomerular
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2
Q

causes of hematuria…

A

TITS:

  1. trauma (foley, blunt, exercise, FB)
  2. Infection / inflam - UTI #1 cause in adults!! glomerulonephritis, AIN, Goodpasture, IgA nephropathy, heoch-shoelien, wegener
  3. Tumor: GROSS PAINLESS HEMATUREIA IS BLADDER / KIDNEY CANCER UNTIL PROVEN OTHERWISE!!
  4. Stones - hypercalciuria
    other: alport syndrome, RTA, heme d/o, meds (cyclosporine, aminoglycosides, analgesics) BPH
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3
Q

initial tests for workup…

A

Urine dipstick and U/A w/ microscopy and examine urine sediment and culture to r/o UTI. cytology w/ malignancy RF

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4
Q

RF for bladder malignancy

A

> 50 y/o, male, smoking, occupational exposure to chem/dyes, painless gross hematuria

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5
Q

diagnostic tests for GU system…

A

image (US/IVP/CT w/ and w/o contrast) upper (kidneys and ureters) and scope lower w/ cystoscopy unless infection present!

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6
Q

hematuria w/ no RBC found on mrico…

A

do dipstick..if positive for heme: mygolobin (clear plasma) or hemoglobin (red) or d/t food (beets) or meds

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7
Q

dark cola urine w/ elevated BP, edema w/ proteinuria w/ RBC casts and dysmorphic RBC on micro…

A

GLOMERULAR! usually glomerulonephritis
think about post-streptococcal GN w sore throat and skin infection 1-2 weeks prior or bergers dz (IgA nephroaphty) w/ 1-2 days of runny nose, sore throat and cough

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8
Q

w/ pyruia present + burning / dysuria on micro…

A

send for culture and tx for UTI

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9
Q

hematuria + hemoptysis

A

goodpastures! check for anca and antibodies to collagen

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10
Q

male w/ hematuria + deafness…

A

alport syndrome!

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11
Q

kid w/ recent viral infection, abdominal pain, arthralgais and purpura…

A

henoch-shoelein purpra

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12
Q

hematuria + little proteinuria micro and clots…

A

extraglomerular! check imaging for renal dz (CT) or bladder (cystoscopy)

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13
Q

UTI bugs

A

1 ecoli

90% d/t e coli, staph saprophyticus, enterococcus
-noninfectious: look for radiation, cyclophosphadmide

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14
Q

UTI - at risk populations

A
  1. diabetics (at risk of UPPER), renal failure
  2. immunocompromised
  3. spinal cord injury
  4. obstruction - neurogenic bladder, reflux,
  5. uncirc males
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15
Q

asymptomatic bacteriuria

A

2 successive positive cultures !(>10x5e)
ONLY TREAT IF PREGO OR BEFORE UROLOGIC PROCEDURE!
**only need 1 in males!

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16
Q

sx

A

void symptoms: dysuria, urgency, frequency
hematuria
suprapubic tenderness
**no systemic / fever

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17
Q

diagnosis:

A
  1. dipstick - nitrites specific for gram neg; leuk esterase key for uti
  2. u/a: criteria
    1. bacteriuria >1 org/field
    2. pyruria more or equal to 10 leuk / miroliter!
  3. urine culture - used more in hospital or w/ recurrent, obstruction, diaphragm use, prolonged >7 days of symptoms, diabetic, 65 and older
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18
Q

complicated UTI

A

considered if:

  1. male
  2. diabetic
  3. immunocopromised
  4. prego,
  5. h/o pyelonephritis w/in last year
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19
Q

tx for uncomplicated UTI

A
  1. keflex 250-500 mg q 6 x 3 days
  2. macrobid 100 mg q 12 hr x 3 days
  3. bactrim (160/800) BID x 3 days
    - can give pyridium for dysuria (turns pee orange)
    - fosfomycin 3 g dose (not really used)
    * *if recurrent w/in 2 weeks of treatment, treat another 2 weeks and get a culture!
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20
Q

prego UTI

A
  1. ampicillin
  2. amoxicillin
  3. augmentin
  4. cephalosporins
    treat x 7 days
    NO FQ
21
Q

male UTI

A 
fconsidered COMPLICATED
1. urologic workup
2. bactrim and FQ
NO MACROBID AND NO BETA LACTAMS!
treat for 7 days if no sx of prostatitis / pyelo!
22
Q

when to consider prophylactic tx…

A

if 3 or more episodes in 1 year!

  • *do urologic eval!!
    1. bactrim (40/200)
    2. macrobid
    3. keflex
  • single dose at bedtime or after intercourse!
23
Q

pyelonephritis!

A

infection of upper urinary tract d/t reflux from bladder
E coli most common bug
uncomplicated if it remains at renal pyelocalyceal-medullary region (complicated can affect any part of kidney)

24
Q

pyelo complications…

A
  1. urosepsis
  2. emphysematous - gas producing bacteria more in diabetics
  3. chronic leading to scarring - often in patients w/ renal disease
25
Q

pyelo sx

A

cystitis + systemic - fever, chills, tachycardia, flank pain, CVA tenderness

26
Q

pyelo diagnosis

A
  1. u/a -LEUKOCYTE CASTS, pyuria, bacteriuria
  2. urine cultures - done in ALL
  3. blood culture - do if ill-appearing or IN HOSPITALIZED
  4. cbc, renal function (if impaired reversible)
    - do imaging if refractory to treatment
27
Q

pyelo tx -outpatient

A

NO MACROBID!

oral: bactrim or FQ (cipro, levo) x 10-14 days
- repeat urine culture in 2-4 days after cessation of tx
- if no reponse, get imaging (CT or ultrasound)

28
Q

pyelo tx - inpatient

A
  • admit if really sick / old / prego / cannot tolerate orals / sig comorbidities / urosepsis
    1. IV ampicillin and gentamicin or cipro
  • *continue IV until afebrile x 24 hrs, then oral to for 14-21 day course
  • once changed to oral:
    2. cipro 750 BID x 21 d
    3. bactrim x 21 days
  • *w/ urosepsis, treat w/ IV 2-3 weeks
29
Q

recurrent pyelo

A
  • if same organism, treat x 6 weeks

- if new organism, tx x 2 weeks

30
Q

ATN

A

85% of intrinsic AKI - two major types

  1. ischemic: prolonged decreased RBF and GFR kills tubular cells! i.e. hypotension, dehydration, shock, sepsis
  2. nephrotoxic: meds -
    • aminoglycosides -often 5-10 days after onset (last in system x 1 mo)
      - cyclosporine (dose dependent - should improve w/ dec dose or stopping med)
    • NSAIDS
      - vanco, acyclovir, amphotericin B (toxic at 2-3 g dose and up)
    • ***RADIOCONTRAST! #3 cause of AKI! give 0.9% NS 1L over 10-12 hr before and after procedure for protection! can give n-acetylcysteine 600 mg every 12 hours twice before and after or sodium bicarb
      - avoid nephrotoxic meds day before and after dye!
    • endogenous: myoglobin w/ rhabdo (check CK - most over 16,000 tx w/ volume repletion!) and hemoglobin (hemolysis / transfusion reaction - tx underlying and hydrate!)
    • hyperuricemia secondary to chemo!
    • bence jones proteins w/ MM
31
Q

ATN labs

A
  • hyperkalemia and hyperphos
  • BUN:crt 2-3% or >20 meq/l
  • GRANULAR MUDDY CASTS!!! RENAL TUBULAR EPITHELIAL CELLS!
32
Q

ATN treatment

A
  • fluids!! volume repletion and stop all nephrotoxic agents!
  • may use loops furosemide w/ chlorthiazide or metolazone to increase urine outpu
    • can use furosemide drip to avoid toxic doses of loops (hearing loss and cerebellar dysfunction)
  • w/ rhabdo - dont treat hypocalcemia unless symptomatic!
  • avoid mag-containing antacids / laxatives - kidney hangs onto potassium, phos, H+, magnesium w/ damage!
33
Q

3 phases of ATN

A
  1. injury

2. oliguric phse: 10-14 days w/ urine output 500 ml/d - GFR increases, BUN:crt begin to fall!

34
Q

AIN patho / causes

A

interstitial inflammation, most commonly due to ALLERGIC (THINK EOS!) TO NEW MEDICATION!!! (PCN, SULFA, CEPH, diuretics, PPI!!! VERA SAID #1 CAUSE, ALLOPURINOL, RIFAMPIN)

  • infection - esp kids - STREP! legionella
  • AI and collagen dz…sarcoid..SLE, sjogrens
35
Q

AIN classic findings…

A

FEVER, RASH, PYURIA, EOS IN URINE!!!

**look for hx of NEW MEDICATION or RECENT ILLNESS! with signs of AKI

36
Q

AIN diagnosis

A

clinical w/ new exposure and has: fever, AKI, rash, eosinophilia!
-get u/a (may have protein /hematuria)

37
Q

AIN tx

A

remove agent - often reverses

w/o improvement, may need steroid (prednisone 60 mg/d x 1-2 weeks or iv methylprednisone x 1-4 d)

38
Q

acute glomerulonephritis…

A

uncommon cause of AKI - inflammatory glomerular lesions w/ proteinuria (<3 g/d) hematuria and RED CELL CASTS W/ DYSMORPHIC RBC!!!

39
Q

glomerulonephritis causes…

A
  1. immune
    • *most common: poststreptococcal GN
    • IgA nephropathy (Berger disease)
  2. anti-gbm / good pasture
  3. vasculitis, collagen dz, SLE, polyarteritis nedosa, henoch shonelein
40
Q

GN pres…

A
  • *boy w/ history of strep infection (sore throat 1-2 weeks prior or skin infection 2-4 weeks prior) w/ new onset periorbital and scrotal edema w/ dark urine
  • dependent edema and HTN
41
Q

GN labs..

A
  • increasing BUN:crt

- U/A dipstick: hematuria, mod proteinuria <3g/d, red cells, red cell casts and white cells

42
Q

whats most specific for GN on dipstick?

A

RED CELL CASTS!!!

43
Q

extra tests to get once Dx GN…

A

completment levels, ASO titer, anti-GBM, ana, anaca, hepatitis, blood cultures, cryoglobulins
-renal u/s

44
Q

nephrotic syndrome…

A

keys: lose protein d/t increased permeability!
1. urine protein >3.5 g/ 24 hr
2. hypoabluminemia
3. hyperlipidemia - get increased LDL and VLDL w/ increase in albumin synthesis
4. edema
- hypercoaguable d/t loss of anticoags in urine
- increased infection d/t increased loss of immunoglobulins in urine

45
Q

testing w/ nephrotic…

A
  1. dipstick - w/ positive get u/a
  2. u/a - RBC cast indicate GN
    - WBC cast = pyelo or interstitial nephritis
    - fatty cast = NEPHROTIC!
    * w/ positive u/a get 24 hour urine collection!
  3. test for microablumin - if positive dipstick, get radioimmunoassay
46
Q

most common causes of nephrotic…

A

adults: membranous glomerulonephritis
kids: minimal change disease

47
Q

nephritic sydrome keys…

A

inflammation of glomeruli w/:

  1. hematuria
  2. AKI - azotemia, oliguira
  3. HTN
  4. edema
    - may have mild proteinuria
48
Q

nephritic causes…

A

1 post-streptococcal!

49
Q

glomerular vs tubular disease..

A

Glomerular is more chronic, causes nephrotic syndrome, requires biopsy and tx w/ steroids
Tubular more acute, d/t toxins, no biopsy no steroids!

pulmonary (16 decks)

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